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Application of a new polyester patch in arthroscopic massive rotator cuff repair significantly improves clinical outcome and tendon integrity
ESSKA Academy. Smolen D. 05/09/18; 212748; P22-561 Topic: Arthroscopic Surgery
Dr. Daniel Smolen
Dr. Daniel Smolen
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Abstract
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Objectives: Massive rotator cuff (RC) tears still present a clinically challenging problem and re-ruptures rates are reported in up to 94%. The purpose of this study was to determine the impact of applying a synthetic patch augmentation for the repair of massive RC tears.

Methods: Between 2012 and 2014, 54 arthroscopic RC reconstructions in 54 patients, augmented with a synthetic polyester patch were performed at the Etzel Clinic in Pfaeffikon, Switzerland. Mean patient age at the time of surgery was 65 years (SD±7.8). Preoperative imaging consisted mainly of arthrographic magnetic resonance imaging (aMRI; 52 patients) and arthrographic computed tomography (aCT; 2 patients). Postoperative imaging was more heterogenous due to patients preference and costs, and included mainly ultrasound-examinations followed by aMRI and aCT. Clinical outcome was evaluated using the Constant-Murley Score (CS) as well as the Subjective Shoulder Value (SSV) pre- and postoperatively. Mean follow up was 32 months (9-50 months). Exclusion criteria were severe osteoarthritis, re-ruptures of formerly repaired RC tears and age over 75 years.

Results: The mean CS increased significantly from 37 preoperatively to 82 postoperatively (40-100; p<0.0001), whereas the mean SSV increased from 40 to 89 (45-100; p<0.0001). Furthermore, patients with intact repairs had significantly more strength compared to patients with re-tears (p<0.0001)
We observed nine complete re-ruptures (16.7%) of the patch-augmented RCs in our radiological follow-up in the investigated 54 patients. Furthermore, three partial re-tears were observed radiologically, not showing relation to the excellent clinical outcome and strength in these patients (5,6%). Additionally, re-ruptures did not correlate with revision surgery, which was performed in eight patients. Only one shoulder was re-operated because of a re-tear of the augmented cuff, receiving a delta-flap after patch explantation. Six revisions were performed due to a frozen shoulder or arthrofibrosis with an intact reconstruction and patch. In one patient the patch was removed due to crepitation. No immunological foreign body reactions were found.

Conclusions: The complete re-tear rate was 16.7%. This compared very favorably to non-augmented massive RC-tear repairs in the literature, where re-tear rates are described in up to 94%. Therefore, we conclude that patch augmentation in massive RC tears is a useful technique to reduce re-tears and improve clinical outcome.

Keywords:
Rotator Cuff, Patch Augmentation
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